Chlordiazepoxide (Librium): dosage, uses, side effects

If you’re struggling to get your drinking under control, you’re not alone—approximately 29% of adults in the United States suffer from alcohol use disorder at some point in their lives (Grant, 2015). But simply quitting may not always be an option. Your healthcare provider may recommend treatment to prevent the withdrawal reactions that can sometimes occur. Find out how Librium can help with these symptoms and if it could be an option for you. 

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Chlordiazepoxide (previously marketed under the brand name Librium) is a prescription medication primarily used to treat alcohol withdrawal symptoms through its anti-anxiety, sedative, and anti-seizure effects. Librium belongs to a group of drugs called benzodiazepines, which work on receptors in the brain and enhance the activity of GABA—a calming neurotransmitter or chemical normally found in your body (Ahwazi, 2020). 

Librium is approved by the U.S. Food and Drug Administration (FDA) for the short-term treatment of acute alcohol withdrawal symptoms. Librium is also FDA-approved to treat anxiety, although healthcare providers typically prefer other drugs to manage anxiety disorders (Solco Healthcare US LLC, 2021). 

Up to 50% of people with alcohol use disorder will develop withdrawal symptoms if they stop drinking suddenly. Chronically drinking alcohol changes the calming and stimulating pathways in your brain. When you stop drinking, the balance of these two pathways is thrown out of whack and causes your brain to go into overdrive (Mirijello, 2015). 

Withdrawal symptoms typically start 6–24 hours after your last drink. Symptoms are often mild, but in some cases, can be serious and even life-threatening. Mild to moderate withdrawal symptoms usually resolve within 2–7 days and include (Mirijello, 2015):

• Fast heart rate

• Headache 

• Irritability and anxiety 

• Nausea and vomiting 

• Restlessness and trouble sleeping 

• Sweating 

• Tremors or feeling shaky 

Fortunately, your healthcare provider can help you manage these symptoms and safely stop drinking. Librium is commonly used to prevent withdrawal symptoms and can make your transition easier. 

Librium is generally well-tolerated, but side effects can occur. Because Librium may cause sedation, do not drive or perform any activity that requires your full attention until you know how it will affect you. Most side effects can be managed by adjusting your dose, so be sure to let your healthcare provider know if you experience any reactions (Ahwazi, 2020). 

Common side effects include (Ahwazi, 2020):

• Confusion 

• Dizziness 

• Drowsiness 

• Forgetfulness

• Problems with balance or coordination (ataxia) 

• Slurred speech 

• Weakness 

Less commonly, people may develop rare side effects including (Ahwazi, 2020):

• A decrease in certain types of blood cells 

• Agitation and hyperactivity 

• Liver problems 

• Rash 

Librium is available in doses of 5 mg, 10 mg, and 25 mg capsules. Your dosing will depend on how severe your symptoms are. For mild symptoms, your healthcare provider may recommend you only take Librium when you need it. Other people may require scheduled dosing that slowly tapers over time as your symptoms improve (Mirijello, 2015). Never take more Librium than your doctor has prescribed since doing so can cause serious effects. 

Librium has several FDA-boxed warnings—warnings that describe serious and potentially life-threatening risks. Be sure to review these warnings before starting Librium and discuss any concerns you have with your healthcare provider (Solco Healthcare US LLC, 2021). 

• Use with opioids: Taking Librium with opioid pain medications (like OxyContin or Vicodin) can cause severe drowsiness, decreased breathing that doesn’t provide enough oxygen to your body, coma, and even death. These medications should only be used together if there are no other alternatives, under the supervision of your healthcare provider, and the dose and duration of treatment should be limited. Be sure not to drive or perform any other activity that requires full attention until you know how these medications affect you. 

• Abuse, misuse, and addiction: Librium and other benzodiazepines have the potential to be abused, and some people may become addicted. Abusing or misusing Librium can involve taking more than your prescribed dose or taking it with alcohol, other drugs, or illicit substances. Abusing Librium increases your chance of overdosing and dying. Always follow your healthcare provider’s instructions for how much to take and store your Librium in a safe location where others do not have access to it. 

• Dependence and withdrawal reactions: You may become physically dependent on Librium, especially if you take it for a long time or at a high dose. This means if you stop taking Librium, you can develop withdrawal reactions, which can sometimes be severe and life-threatening. Some people experience long-term withdrawal symptoms that can last weeks to more than 12 months. If treatment with Librium is no longer needed, your healthcare provider will likely slowly decrease your dose over several weeks or more to help prevent withdrawal. 

Pregnancy and breastfeeding 

If you’re pregnant or plan to become pregnant, talk to your healthcare provider before starting Librium. Librium is not recommended during pregnancy since it increases the risk of birth defects and pregnancy complications. Librium also crosses into breast milk, so breastfeeding while taking Librium is generally not recommended (Solco Healthcare US LLC, 2021). 

Other conditions 

Certain conditions may increase your chance of developing complications from Librium. Let your healthcare provider know about all your medical conditions, including:

• A history of alcohol or drug abuse 

• Depression, mood problems, or suicidal thoughts or behaviors 

• Liver or kidney problems 

Before starting Librium, review all the medications you take with your healthcare provider so they can check for any potential drug interactions. Here are some of the most common interactions to watch out for:

Opioids 

Using opioids with Librium can cause serious side effects, including oversedation, respiratory depression (decreased breathing and reduced oxygen levels), coma, and death. Opioid pain medications include:

• Codeine

• Fentanyl 

• Hydrocodone (found in Vicodin) 

• Hydromorphone 

• Methadone 

• Oxycodone (found in Percocet, OxyContin) 

• Tramadol 

Other sedating medications 

Taking Librium with other sedating drugs can increase the sedative effects of Librium. Drugs that cause sedation include:

• Alcohol 

• Barbiturates like phenobarbital 

• Certain antidepressants and antipsychotics like trazodone (Desyrel), olanzapine (Zyprexa), and quetiapine (Seroquel) 

• Other benzodiazepines like diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan) 

• Sleep medications such as eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon

Librium may interact with many other medications not listed above. Keep an up-to-date list of all the medicines you take, including prescription drugs and over-the-counter products and supplements. Always check with your healthcare provider before starting anything new. 

Deciding to quit drinking is a big step—and one that you should be proud of. It’s normal to feel anxious about withdrawal effects, especially if you’ve experienced symptoms in the past. Talk with your healthcare provider about your plans to quit. They may recommend Librium as part of your plan to help your transition be as easy and comfortable as possible.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

October 13, 2021

Written by

Christina Varvatsis, PharmD

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.